May 24th – VCSQI Opioid Management Workgroup Today’s Objectives and Agenda Review why we’re doing this work Display survey results Recommended Actions Tell us your story! Today’s agenda is organized around our objectives for today, as seen here.

Opioids: Why This Work is Important

Opioids: Why This Work is Important

VCSQI Survey: Opioid Prescribing Practices-March 2018 Thursday, May 24, 2018

12 Total Responses Date Created: Wednesday, March 14, 2018 Complete Responses: 10

Q4: Do any clinicians in your practice prescribe opioids? Answered: 12 Skipped: 0

Q4: Do any clinicians in your practice prescribe opioids? Answered: 12 Skipped: 0

Q5: Does your practice have an opioid prescribing protocol used by your clinicians? Answered: 7 Skipped: 5

Q5: Does your practice have an opioid prescribing protocol used by your clinicians? Answered: 7 Skipped: 5

Q6: Do your prescribers use the your state's Prescription Drug Monitoring  Program (PDMP) when prescribing opioids? Check all that apply. Answered: 7 Skipped: 5

Q6: Do your prescribers use the your state's Prescription Drug Monitoring  Program (PDMP) when prescribing opioids? Check all that apply. Answered: 7 Skipped: 5

Q7: Do your prescribers assess a patient's risk of addiction prior to prescribing an opioid? Answered: 7 Skipped: 5

Q7: Do your prescribers assess a patient's risk of addiction prior to prescribing an opioid? Answered: 7 Skipped: 5

Q8: Does your practice have prescribing restrictions for the number of opiate pills prescribed? Answered: 7 Skipped: 5

Q8: Does your practice have prescribing restrictions for the number of opiate pills prescribed? Answered: 7 Skipped: 5

Q9: How many days/weeks of opiate pain medication do your prescribers typically prescribe? Answered: 7 Skipped: 5

Q9: How many days/weeks of opiate pain medication do your prescribers typically prescribe? Answered: 7 Skipped: 5

Q10: On average, how soon does your team follow up with patients who are receiving opiates? Answered: 7 Skipped: 5

Q10: On average, how soon does your team follow up with patients who are receiving opiates? Answered: 7 Skipped: 5

Q11: Do your prescribers document in the medical record a signed "opioid treatment agreement" between the patient and prescriber? Answered: 7 Skipped: 5

Q11: Do your prescribers document in the medical record a signed "opioid treatment agreement" between the patient and prescriber? Answered: 7 Skipped: 5

Q12: Do you have a patient/family education process to jointly determine how the patient can best manage pain and inform the patient of risks associated with opioids? Answered: 7 Skipped: 5

Q12: Do you have a patient/family education process to jointly determine how the patient can best manage pain and inform the patient of risks associated with opioids? Answered: 7 Skipped: 5

Q13: Does your patient/family education material include information about how to safely dispose of unused opioids? Answered: 7 Skipped: 5

Q13: Does your patient/family education material include information about how to safely dispose of unused opioids? Answered: 7 Skipped: 5

Q14: Where do your clinicians primarily see patients Q14: Where do your clinicians primarily see patients? (check all that apply) Answered: 7 Skipped: 5

Q14: Where do your clinicians primarily see patients Q14: Where do your clinicians primarily see patients? (check all that apply) Answered: 7 Skipped: 5

Q15: Do you currently measure/track opioid prescribing practices with your patients? (Check all that apply). Answered: 7 Skipped: 5

Q15: Do you currently measure/track opioid prescribing practices with your patients? (Check all that apply). Answered: 7 Skipped: 5

Q17: Are there any questions we did not ask that you would like to address, or that you think we SHOULD ask in future surveys on this topic? Open comment box Answered: 6 Skipped: 6

Q17: Are there any questions we did not ask that you would like to address, or that you think we SHOULD ask in future surveys on this topic? Open comment box Answered: 6 Skipped: 6

Survey Take-Away’s Most practices that prescribe opioids do NOT have a protocol The state’s PDMP is being used to check for other scripts Patient’s risk is being assessed prior to prescribing Prescribing limits exist, but most at 14 days, with follow up in 2 weeks Signed treatment agreement not being used, but discussion about risks is usually done Discussion about safe disposal not usually done Minimal measurement of opioid prescribing practices Should ask about naloxone prescribing

Recommended actions Review your state’s laws – there have been many new ones passed that require checking PDMP and have dosage and duration limits Establish a prescribing protocol that meets the law’s expectations* Consider non-opioid treatment regimens Document assessment of patient’s risk Consider a signed treatment agreement with chronic pain patients and those at high risk for addiction Consider monitoring the practice’s prescribing patterns to confirm compliance with law and best practices *https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

Opportunities for Positive Change Treatment and reimbursement Medication-assisted treatment (MAT) Evidence-based non-opioid treatment options Tools to prevent overprescribing Prescribing limits Prescription Drug Monitoring Programs (PDMPs) Screening, education, and communication Provider and patient education

In the Words of a Patient… “I'm a good person. I'm a contributing member of society. I'm educated. I have a good job, make good money, have wonderful relationships with my loved ones. I'm so completely average. The only thing that sets me apart from that other young business professional that seems to have it all is that I'm addicted to opiates.” Source: http://apps.frontline.org/heroin-stories/story/42422-65836.html

Tell Us Your Story to Improve Prescribing Practices Demographic information Strategies used Type of initiative (i.e., decreasing opioid usage, increasing treatment access, etc.) Data collection methods Initiative success Person and Family Engagement (PFE) methods